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Saturday, December 22, 2012

The post-Sandy Hook conversation we should be having

How long after release of the news of the tragedy in Newtown
did it take the Usual Suspects to start arguing about gun control?Was it more than thirty-six hours?Had the names of any of the children been
released?

It’s the same bloody non-conversation we’ve been having
since I wrote my first “letter to the editor” thirty years ago, the same
tug-o’-war between those who want to give teachers permits to carry Uzis and
those who want to register anyone who buys so much as a Super Soaker.[Case in point: this loony screed on The Slate. But then, this equally nutty proposal from the NRA's Wayne LaPierre didn't help either.]A Boise writer named Liza Long did write a thought-provoking
piece for The Blue Review; outlets like HuffPo, TIME, MSN and Yahoo all
reprinted it, paused for a breath … and resumed the non-conversation.(Although HuffPo for some reason wasted two
or three posts on Asperger’s syndrome, an autism spectrum disorder which they
finally admitted has no causal connection to violent behavior.Typical — shoot first, do the research later.If necessary.)

On the liberal side, the major failing is that the tragedy in se hasn’t inspired any policy
suggestions that really, specifically address such mass murders … except for
reinstating the ban on assault rifles.On the conservative side, the major failing is the tendency to engage in
amateur psychology: the Adam Lanzas all hit soft targets, like schools and
malls, because no one is likely to shoot back at them and they can get their
fifteen minutes of fame with no real risk, don’cha know.

(Hitting vulnerable, low-risk targets for the sake of fame
may be a motive for a certain kind of serial killer … but for a mass murderer
who ends his rampage by blowing his brains out?Bah-loney.)

Here is the truth: Today, even a mentally
ill young man with a known propensity for violence, or even a history of
serious violence, is likely to receive just an hour a week of counseling (if
that) by a social worker.

He is likely have an unclear diagnosis of his
condition and to be on a list of constantly changing, very powerful
psychoactive medications prescribed by a nurse.

He is also likely to be turned away — repeatedly
— by emergency room social workers who act as gatekeepers for insurance
companies to restrict access to inpatient psychiatric treatment.

If admitted to a psychiatric hospital, he will
likely be triaged quickly through an often-incompetent “tune up” of medications
that might accomplish nothing and then be sent back home as soon as he
“contracts for safety” — simply promising a social worker that he won’t kill
anyone.

That young man’s good parents might well pray that
he be arrested for another violent crime so that the terms of his probation
might (but probably still wouldn’t) include mandatory visits to a mental health
professional (though not always the right one for their child’s needs) and
mandatory drug testing. At least then he can be jailed if he refuses all
treatment or gets hold of some heroin that could worsen his hallucinations.

Moreover, Dr. Ablow mourns, since insurance companies drive
down their costs by pushing treatment to the least-trained clinicians possible,
training programs for psychiatric residents have responded by curtailing
education in “the essential art of helping [to] understand the roots of
psychiatric illness in emotion”, a problem exacerbated by “[the] constantly
changing, partly insurance-company driven” Diagnostic
and Statistical Manual of Mental Disorders, which describes treatment
mostly in terms of medications.

And even when the insurance companies are willing to pay for
inpatient treatment, it’s for overcrowded psychiatric units where the psychotic
are “lumped into one space (and share rooms) with depressed young adults, drug
addicted homeless folks and the elderly suffering from dementia.”The stays are too often too short, and simply
result in another prescription for a different psychoactive medication that may
or may not work — if the patient takes it.

By the way, nothing in the Obamacare Act fixes any of this.President Obama has supposedly put mental
health on the table of items for the
new task force VP Biden is heading to look at.White House press secretary Jay Carney said,
in speaking of gun violence, “It’s a complex problem that requires more
than one solution. … It calls for not only re-examining our gun laws and how
well we enforce them, but also for engaging mental health professionals,
law-enforcement officials, educators, parents and communities to find those
solutions.” However, the best opportunity for the Administration to look at mental
health care passed with the end of the PPACA fight, which sapped a lot of Obama’s
political capital.

At least in Connecticut they’re talking about mental
health.Barnini
Chakraborty of FOXNews notes, “Ironically, a Connecticut mental health bill
calling for changes that could have taken someone like shooter Adam Lanza off
the streets was defeated earlier this year in the state legislature. The bill
would have allowed the state to commit someone if there was a reason to think
that would prevent them from harming others.”Virginia tightened its mandatory outpatient treatment procedures and
increased funding for mental health services in the wake of the 2007 Virginia
Tech massacre.But in other states,
mental health care budgets have been cut and facilities closed, nominally as misguided
responses to problems of corruption and brutality … but more to save money.

Mental health care is just part of a hot mess of a national
health care system that, in the words of the Institute
of Medicine’s September report, “lags in its ability to adapt, affordably
meet patients’ needs, and consistently achieve better outcomes.” In large part, the market has failed to drive
down health care costs because health care as an industry is still too
fragmentary. With the exceptions of
pharmaceutical companies, equipment manufacturers and some hospitals,
health-care provision is at the same point that ironworking was prior to the
Industrial Revolution — small, community-based and individually-owned shops without
effective centralized organization, incapable of taking advantage of the
economies of scale.Maggie
Fox of NBC reports:

If banking were like health care, it would take
days to get money out of an ATM because the records would be lost. If airlines were like health care, pilots
would decide on their own which safety checks to make, if any. If shopping were like health care … “Product
prices would not be posted, and the price charged would vary widely within the
same store, depending on the source of payment,” the [IOM] report says.

It’s past time for us to make meaningful, systemic changes
to our health care system that do more than just socialize the costs and
entrench the insurance companies more firmly in control of treatment.As part of those changes, we need to find
better prevention and treatment protocols for mental illness, protocols that
aren’t driven solely by the desire to save money and boost profits.

This is the conversation we should be having.It’s the conversation we won’t have, however,
so long as we focus on the gun and not on the person pulling the trigger.

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